Permit Support Document Plumbing Permit AppDREG EIVED q-1 ` " B
Building Fixtures SEP 01 2020 FOR OFFICE USE ONLY
City of Tigard Received
T TIGA DateBy: I/.� f%Q Per t N°.1�1STZts j J G9aV 4
• 13125 SW Hall Blvd.,Tigar RD j� Plan Review
Phone: 503.718.2439 Fait? �C��Ntr,�r� pp a r1 A Other Permit No.:
111 '. naAV�r��V(V� Date/By: _I 7'I '1t1 G
ONI
Inspection Line: 503.639.4175 Date Read B q 7 ® See Page 2 for
TIGARD Internet: www.ti and-or. ov y o / '2Y �O g
g g No[ificd/Mcthod: � //�J Supplemental Informuli°n
,l� TYPE OF WORK 4-g�, T-�j/q/,T,f FEE* SCHEDULE
6 New construction ['Demolition
Far special information use checklist
Description I Qty. I Ea. I Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
gi-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 500.32
❑Accessory building ❑Multi-family
Each additional bath/kitchen 25.02
❑Master builder ❑Other: Fire sprinkler(ill lq.ft.) Page 2
JOB SITE INFORMATION AND LOCATION Site utilities:
Job site address: 14.14'.1 c A lbQ-i k Catch basin or area drain 18.76
AILS')
Drywell,leach line,or trench drain 18.76
City/State/ZIP: �G I c) Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: • GE Project name: (L JSF(A.L. Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
4 L \`'- I l A�L�' 1 4- Rain drain connector 18.76
l7 �> Sanitary sewer(no.linear ft.: ) Page 2
Storm sewer(no.linear ft.: ) Page 2
Water service(no.linear ft.: ) Page 2
Subdivision: I Lot no.: Fixture or item:
Tax mapiparcel no.: Backflow preventer 31.27
DESCRIPTION OF WORK Backwater valve 12.51
Clothes washer 25.02
Dishwasher 25.02
ENQe- \\�Q,t(`l(AeZ, '� I/
( S F.-Q t� Drinking fountain 25.02
Ejectors/sump 25.02
❑ PROPERTY OWNER ❑ TENANT Expansion tank 12.51
Name: H
��n___ Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:
Garbage disposal 25.02
City/State/ZIP: Hose bib 25.02
Phone:( ) Fax:( ) Ice maker 12.51
❑ APPLICANT 0 CONTACT PERSON Interceptor/grease trap 25.02
Business name: Medical gas(value:$ ) Page 2
Primer 12.51
Contact name: Roof drain(commercial) 12.51
Address: Sink/basin/lavatory 25.02
City/State/ZIP: Solar units(potable water) 62.54
Phone:( ) Fax::( ) Tub/shower/shower pan 12.51
E-mail: Urinal 25.02
Water closet 25.02
CONTRACTOR
Water heater 37.52
Business name: eS2000 2A, .k- ) Mock ` -n. cc t Water piping/DWV56.29
Address: 1O.a S 1'r``l"�� . kmkf (21iRi_ V Other: 25.02
`City/State/ZIP: ea( dt 4`�(� Subtotal
Phone:(SCfa, (0(0� l Fax:(9 (06 a. RSA' Minimum permit fee: $72.50
CCB Lic.: t i• '0a' O lumbing Lic.no.:c).(o• Yia1.1 (; Plan review (25%of permit fee)
` State surcharge(12%of permit fee) a
Authorized signature TOTAL PERMIT FEE 13 to. 5 3
' I t This permit application expires if a permit is not obtained within 180 days
Print name: M 0 ,(r (1s,.. Date: a
after it has been accepted as complete.
*Fee methodology set by Tri-County Building Industry Service Board.
I:1 Building\Penults\PLMU-PermitApp.doc 10/01/09 440-4616T(10/02/COMiWEB)